Inspection on 19/06/07 for The White House

This inspection was carried out on 19th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The White House 05/07/06

The White House 25/01/06

The White House 20/07/05

The White House 08/12/04

The White House 17/05/04

The White House 09/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 White House (The) 4 Walpole Road Boscombe Bournemouth Dorset BH1 4EZ Lead Inspector Tracey Cockburn Key Unannounced Inspection 19th June 2007 10:10 White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White House (The) Address 4 Walpole Road Boscombe Bournemouth Dorset BH1 4EZ 01202 399471 01202 390473 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Steadway Care Limited Mrs Sheila Mary Stimpson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Further work needs to be undertaken to the window in Bedroom 8 prior to the registration of this room. Following the recommendation made by Dorset Fire & Rescue Service in their letter dated 28 August 2002; careful consideration needs to be given to the choice of service user who can be accommodated in the top floor rooms such that these service users should be able to evacuate the building unaided. Service users who have significant personal care needs or who present with very challenging behaviour will not be offered places. Two named persons (as known to the CSCI) to be accommodated in the category LD to be provided with one to one care. 5th July 2006 3. 4. Date of last inspection Brief Description of the Service: The White House is a large property on a corner plot in a residential area of Boscombe. It is conveniently located for all the amenities of Boscombe that includes shops, restaurants, cafes, post office, library and places of worship. These are within a few minutes level walk of the home. Public transport is readily accessible close to the home and Bournemouth town centre is approximately 1 mile from the home. The home has its own transport that enables service users to conveniently access some of the towns leisure facilities, particularly when group activities are arranged. The homes mission statement states that that it aims to support and care for adults with autism along the path towards independence. The White House has three floors and there is bedroom accommodation on the first and second floors i.e. 2 on the second floor and 5 on the first. All bedrooms are single rooms and have en-suite WCs and baths and the décor and furnishings are the choice of the person occupying the room. Communal space is on the ground floor and comprises two lounges, a dining room, a large kitchen and a WC. Recent extension work has provided a larger management office, additional staff office and separate laundry room. The paved external garden area is accessible from one of the lounges and the dining room and contains a summerhouse. The current weekly fees are between £1842 and £2486, which are inclusive of day care activities provided during the week. Additional charges are made for hairdressing, toiletries, and some activities. For further information on fee levels and contract visit the office of Fair Trading website: www.oft.gov.uk White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the service and took place between 10:10am and 3:30pm. This inspection assessed the entire key National Minimum Standards for care homes for adults (18-65) Part of the information gathering process prior to the visit to the home included reviewing the information received about the service. This included any notifications made under regulation 37, monthly monitoring visits to the home by the responsible individual, any adult protection investigations, complaints and analysing the information received in the Annual Quality Assurance Assessment (AQAA). During the course of the visit to the service, the manager and deputy were spoken to. Records including care plans, staffing records, medication records, maintenance records and training were looked at. A tour of the premises also took place. At the time of the inspection there was only 1 person in the home. The other people who live there were working at the allotment. They arrived back in the afternoon. Some observation of activities between staff and residents took place before everyone went out. 5 survey forms were left for people who use the service and 5 were left to pass on to relatives. 2 survey forms were sent to healthcare professionals. At the time of writing the report 5 survey forms were returned. What the service does well: People who use the service have their needs and aspirations individually assessed. This means that the home know they can meet an individual’s needs before they move in. Regular reviews take place involving all the people involved in the care of the individual. The process of gathering information ensures that changes are clearly recorded. People are supported to make decisions in their daily lives. Risk assessments are thorough and enable people who live in the home to have a lifestyle, which interests them. People who live in the service are able to participate in activities, which interest them in the community. They take part in a variety of leisure activities and have relationships with the people that are important to them. The people who live in the home are offered a healthy diet. Information is recorded about the way people like and need to be supported in their daily lives. There is good recording of the care needs both physical and emotional, which means that staff have the information they need to do a good job. The staff have received training in adult protection and have the knowledge to ensure that people are protected. They have learned from an adult protection investigation. There is a nice atmosphere in the home and it is furnished in a White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 6 homely way. The home is clean. Staff have a mixture of skills and experience which means they are able to meet the diverse needs of the people who live there. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who might use this service have their needs and aspirations assessed. They are given the information they need to choose a home, which can meet their needs and aspirations. EVIDENCE: At the time of the inspection there had been no new admissions to the home since the last inspection. There are currently 5 people living in the service. Previous inspections have found full care management assessments and care plans in place for all the people who live in the service. Contracts are in place for all 5 of the people currently living in the service. The contract, which was missing at the previous inspection, was in the persons file. In the services annual quality assurance assessment they state they are planning to make the home statement of purpose available on the Internet as a download document. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in this service have individual plans, which reflect their changing needs and goals. People who live in this service are encouraged to make decisions about their daily lives and supported to take risks. EVIDENCE: As part of the inspection 1 individual’s file was examined. This contained a personal profile and plan, which had information on a wide range of needs including; communication, personal care, relationships, behaviours, risk. There was also information in the care plan on the person’s ethnic background and culture and what this might mean for them in terms of support and activities. The file looked at contained information on care management reviews; the last review took place in February 2007. There was written evidence that both the resident and their family had been consulted prior to the review. The service has a skills monitoring system for each resident, which details progress and White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 10 achievements in a wide variety of skills areas. This system includes activities both in and out of the home such as using a washing machine and bowling, This information is also part of the review process. There is information on each individual’s vocabulary, lists of words they use, what they mean for that person. This gives the staff the information they need to support each resident. The care plan looked at contained detailed information on the individual’s behaviour and what action staff need to support that individual. In discussion with the manager she said that they work hard to use health care professionals who understand the needs of people who live in the service. So for this reason the dentist the home uses is in Poole and the optician is in Wareham. Some of the residents are able to make only limited choices in their daily lives. Care plans contain information on restrictions in their daily lives and the reasons why. During the inspection 1 resident was in the home and this person was observed making choices about activities to do during the day and what to eat for lunch. Risk assessments were detailed and covered a variety of activities such as going to the bottle bank, going to the allotment, personal care, domestic activities. The risk assessments were reviewed and updated. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in this service are supported to take part in activities, which interest them in the local community. EVIDENCE: On the day of the inspection all but 1 resident had chosen to go up to the allotment the home has. The manager said that the residents get a great deal of pleasure from working at the allotment and especially enjoy bringing the vegetables back to cook and eat. The residents came back in the afternoon, but several then went off to take items to recycling. Staff were observed responding to individual requests and deciding what activities would be enjoyed. There is a large day activities programme chart on the wall in the hall. This uses a mixture of signs, symbols and pictures depending on each individual’s White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 12 preferred method of communication; to demonstrate clearly what activities they have each day. The activity programme demonstrates that people are able to access the community and be part of the community on a daily basis. The home has a large vehicle so that the residents can go out and about when they want to; staff rotas show there was 3 care staff on duty as well as the manager and the deputy manager. Information about family contacts is clearly recorded on individual files. The homes service user guide makes it clear that individuals are encouraged to have regular contact with their families and friends. The document also states that residents have the right to choose who visits them. In the homes annual quality assurance assessment they state the different ways they try to improve the lifestyle for residents by discussing the issue at staff meetings. During the inspection the resident who was around in the home was supported to make their own lunch. Other residents are also encouraged to develop their daily life skills including housework, being responsible for their own rooms and helping with things like unpacking the weekly shopping. The weekly menus were varied, with lots of healthy fresh fruit and vegetables. The fridges and freezers were well stocked. The manager was concerned that the freezer was not as well stocked as it could be but explained they were waiting for the weekly delivery of frozen goods. The kitchen appears bare with no kitchen utensils out; this is necessary to protect the residents from harm. The manager explained that residents do work in the kitchen but with very close supervision. The staff are aware of the cultural needs of the residents and provide specific foods for those residents when they want them. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Each residents personal care needs are clearly documented in care plans covering all aspects of personal care such as washing, bathing, shaving, hair care. Individual health issues are clearly recorded in care plans. There was recorded evidence that residents are supported to attend appointments with opticians and dentists. There was also written information on visits by other healthcare professionals such as the community nurse. Residents are taken to see the psychiatrist and psychologist when requested to or when they are concerned about someone’s behaviour or medication. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 14 The home has a policy on the management and administration of medication. No resident living in the home at the time of the inspection had been assessed as able to self-administer their own medication. Medication is stored securely in a locked metal cupboard. Records checked on the day of the inspection were found to be accurate and up to date. The requirement made at the previous inspection had been met. The manager demonstrated what they now do if there are any changes to pre printed sheets. There is also a clear procedure for recording medication, which leaves the home when a resident is out for the day or away with family for longer. The home has never had an incident with medication coming back, which shouldn’t. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service have access to a clear complaints procedure and are supported to make their views known. The service has trained staff to understand how to protect people from abuse. When there are allegations management take responsibility and learn from any investigations. EVIDENCE: There is a detailed written policy and procedure about how to complain. The home has produced a leaflet both written and using pictures. The manager has written in the annual quality assurance assessment that they have an “open door” policy and encourage people to talk about issues or problems they encounter with the service. The manager says that they use the communication book, handover file and service user diaries to review information and concerns. This process of information gathering also feeds into their individual reviews. The manager is developing a feedback form to be completed by families after they have had home visits with residents to establish any changes in behaviour, which might have occurred. The home has a policy and procedure on the protection of vulnerable adults and how to report incidents of abuse. A sample of staff training records were reviewed and staff have received training in this area. Since the last inspection there has been one reported allegation of abuse, which has been investigated by the local authority. The manager of the service White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 16 expressed concern that they had not received written confirmation of the outcome of the investigation. The home has updated their service user guide to make it clear that they provide a service to people with challenging behaviour however they do not provide a service to anyone who could be violent. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service live in a homely environment, which is comfortable, safe and clean. They are encouraged to be responsible for the environment they live in. EVIDENCE: A tour of the premises took place as part of the inspection. All communal rooms were seen this includes, 2 lounges, kitchen, dining room, and laundry room. 1 resident’s bedroom was seen. There is new fencing around the home, which has afforded more privacy to the home. The home is well maintained and decorated in a homely way and is designed to support adults with have a diagnosis of autism or whose problems are associated with an autistic spectrum disorder. The one bedroom seen was personalised. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 18 On the day of the inspection the home was clean and hygienic. The home has a laundry room, which is not near the kitchen. There is a health and safety file in the home, which includes information on infection control. Staff receive training in infection control as part of induction. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in the service are supported by staff that are competent to do the job and receive the training they need to meet people’s individual and joint needs. Recruitment practice has improved this means people who live in the service are protected. EVIDENCE: The home has a registered manager, deputy manager and training coordinator, there is also someone who co-ordinates day care. Senior support workers are responsible for supervision of support workers. The information staff receive in induction enables them to understand the needs of the people who live in the home. The manager says they try to employ people who demonstrate an aptitude for working with their residents. They assess this during their probationary period. All staff are encouraged to participate in NVQ training and the home have reached the target of more than 50 of staff achieving a care NVQ 2 or above. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 20 The senior support worker said that she had undertaken a supervisory course before undertaking this role as well as a team-leading course. The deputy manager has NVQ level 4. The manager said that they are arranging free counselling for staff as they recognise that the role is very demanding. In the annual quality assurance assessment provided by the home they say they have a comprehensive recruitment and selection process. 1 file for a new member of staff was reviewed and this had a satisfactory criminal records bureau check as well as a police check from the country of origin, which had been translated into English. There was a completed application and notes from the interview process. At the last inspection there was a requirement regarding checks being completed including work permits and references. On the file seen and in discussion with the manager it had been very difficult to find references for this person. The manager had sought verbal references and had gone to the person’s previous place of work to thoroughly check them out. This was not fully documented but it was clear from the discussion that they had done as much as they could to verify who they were and their employment track record. There was a signed contract with terms and conditions on the file. Each member of staff has a training needs assessment, records show the training which has taken place and the updates needs. Courses provided include first aid, health and safety, medication and infection control. The home has a 12-week induction for new staff. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in this service benefit from a well run home. Their views form part of the development of the service. Systems are in place to ensure that people who live in the service have their health, safety and welfare promoted and protected. EVIDENCE: The registered manager has completed her registered managers award (RMA). Confirmation has been received by e-mail from the course tutor that all the work has been completed and the course passed. The manger has many years experience in working with people who have autism. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 22 Previous inspections have demonstrated the homes quality assurance process. The manager carries out monthly management checks; the responsible individual carries out monthly visits. The annual development plan, which was not available at the previous inspection, was supplied to the commission after the last inspection. At the previous inspection it was found that PAT testing was not up to date, this was rectified and found to be up to date at this inspection. Training in fire safety, food hygiene and infection control were up to date. No substances were found to be incorrectly stored. The manager maintains a record of all checks carried out including water temperatures, fridge and freezer temperatures and weekly vehicle checks. The maintenance log was up to date and items were signed and dated when complete. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 White House (The) 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score Score 3 3 3 X 37 38 39 40 41 42 43 DS0000032243.V343442.R01.S.doc 3 X 3 X X 3 X Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA34 Good Practice Recommendations The registered person should make sure they record in the person’s personal file all the action taken to obtain 2 written references. White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI White House (The) DS0000032243.V343442.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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